BP in Pregnancy Tied to Cardiac Health Later

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Hypertension in pregnancy appears independently linked to heart, kidney, and metabolic problems later in life, even when it doesn't reach the level of preeclampsia, a study has found.

Note that although the highest risks were from the combination of chronic hypertension and preeclampsia or eclampsia, isolated systolic or diastolic hypertension that resolved during or soon after pregnancy also correlated with elevated risks.

Hypertension in pregnancy appears independently linked to heart, kidney, and metabolic problems later in life, even when it doesn't reach the level of preeclampsia, a population-based study showed.

Gestational hypertension without proteinuria was associated with 44% to 300% elevated risks of problems ranging from fatal heart attack to kidney disease, stroke, heart failure and diabetes over almost 40 years of follow-up, Tuija Männistö, MD, PhD, of the National Institute of Child Health and Human Development in Rockville, Md., and colleagues found.

Although the highest risks were from the combination of chronic hypertension and preeclampsia or eclampsia, isolated systolic or diastolic hypertension that resolved during or soon after pregnancy also correlated with elevated risks, the group reported online Feb. 11 in Circulation: Journal of the American Heart Association.

"Detection of hypertension during pregnancy warrants further cardiovascular disease risk factor screening and at least counseling on lifestyle factors to reduce disease risk," they recommended.

Hypertension during pregnancy is common, affecting a third of pregnant women in their analysis of Finnish registries.

"As a physiological stressor, pregnancy may uncover susceptibility to subsequent chronic disease, particularly of a vascular or metabolic origin," Männistö's group explained.

However, there are no diagnostic criteria for isolated new-onset elevated systolic or diastolic blood pressure in pregnancy, and these aren't independently recorded in administrative data or discharge summaries, they pointed out.

"Post pregnancy, these women are somewhat lost in the shuffle," Roxana Mehran, MD, an interventional cardiologist at the Mount Sinai School of Medicine in New York City and who was not involved in the study, said in an interview. "We're not following them as closely as we should."

Guidelines from the American Heart Association recommend asking women about pregnancy complications as part of history taking and put preeclampsia roughly on par with a failed stress test as a risk factor.

"The time has now come for us to really focus on heart disease in women as early as their time of gestation," Mehran urged. "For the most part, coronary disease and cardiovascular disease develops later in women than it does in men in terms of age, but this kind of a study really tells you women need the attention much earlier in life rather than waiting until disease develops."

The study analyzed gestational blood pressure prospectively recorded for 10,314 women from prenatal care and questionnaires as part of the Northern Finland Birth Cohort 1966, using a threshold of 145/95 mm Hg for hypertension rather than the current cutoffs of 140/90 because values were rounded to the nearest 5 mm Hg in the 1960s.

The women were followed-up through Finnish healthcare registries for an average 39 years, to a mean 67 years of age.

Gestational hypertension -- defined as onset after the 20th week of gestation without proteinuria -- developed in 991 women. Compared with normotensive gestation, it was significantly associated with the following:

44% higher risk of ischemic heart disease

75% elevated risk of myocardial infarction

300% higher risk of death from a myocardial infarction

78% higher risk of heart failure

59% elevated risk of ischemic stroke

91% higher risk of kidney disease

52% higher risk of diabetes mellitus

Isolated systolic hypertension at any time during pregnancy without proteinuria occurred in 866 of the women. It was associated with 2.15-fold elevated risk of fatal MI, 43% higher risk of heart failure, and 42% elevated diabetes risk, all significant, compared with normotensive women.

Isolated diastolic hypertension at any time during gestation but without proteinuria, which affected 742 women, correlated with ischemic heart disease (hazard ratio 1.26, 95% CI 1.05 to 1.50).

Chronic hypertension and preeclampsia or eclampsia, alone or superimposed, also were associated with higher risks, as expected.

A sensitivity analysis confirmed the impact among women even in the absence of other risk factors (nonsmokers younger than 35 with normal weight and no diabetes during pregnancy), "suggesting that hypertension during pregnancy has an independent effect on long-term risk," the researchers wrote.

They acknowledged the potential for misclassification of some isolated hypertension, which may have been classified as preeclampsia or gestational hypertension under current diagnostic criteria, and the lack of data on changes in cardiovascular risk factors during follow-up.

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